2014 Congress of Delegates

Members Debate Wide Range of Public Health Policy Issues

AAFP members attending the 2014 Congress of Delegates here took up a diverse set of resolutions during the advocacy reference committee hearing on Oct. 20, discussing topics that ranged from rapid diagnostic testing by pharmacists to working with the DEA to ease restrictions on writing electronic prescriptions for controlled substances. Delegates continued some of these discussions during the following day's business session.

New physician alternate delegate Brent Smith, M.D., discusses the need to take a stand against the use of rapid diagnostic testing by pharmacists during the 2014 Congress of Delegates.

Rapid Diagnostic Testing by Pharmacists

According to a resolution introduced by the Michigan AFP, pharmacists in several states are taking an active role in administering rapid diagnostic tests to patients, interpreting the results and prescribing treatment, a development that worries family physicians.

Speaking in support of a resolution that called for the AAFP to educate states about the spread of such practices, Illinois delegate Kathleen Miller, M.D., of Decatur, parsed the topic into segments when she told reference committee members, "It's not the testing that's the problem. It's the scope of practice to treat based upon testing that needs to be addressed."

"Pharmacists are an important part of the health care team," Michigan delegate Angelo Patsalis, M.D., of Livonia, acknowledged during the Oct. 21 business session. However, he added, "They are not independent physicians. The role of pharmacists is not to administer tests or make diagnoses. They should not be following up with patients."

Story highlights

Many FPs who testified before the advocacy reference committee during the 2014 Congress of Delegates expressed concern about the prevalence of rapid diagnostic testing by pharmacists.

Delegates adopted a resolution that aims to ease restrictions on electronic prescribing of controlled substances.

The delegates voted down a measure that called for the AAFP to support a single-payer health system, but reaffirmed the need for the Academy to be at the table for such discussions.

Physicians warned that if the expansion of diagnostic services by pharmacists continues without action at the state level, more patients might decide to seek treatment at a pharmacy instead of consulting with their physician.

"In the future, if we don't take a stand on this, then 'the corner of healthy and happy' will be, "Help me find a job,'" said new physician alternate delegate Brent Smith, M.D., of Cleveland, Miss., during the business session.

Michigan delegate Robert Reneker Jr., M.D., of Wyoming, said that pharmacists in his state are giving lectures on expanding their practices to include procedures such as diagnostic testing that have traditionally been provided by a physician. Still, he said during the business session, "This is in no way about a turf battle. It's dangerous for patient care and should not happen."

According to one member, as pharmacists expand their range of services to patients, their traditional roles of handling delivery of medication and communicating with the physician are being neglected.

"I would be happy if pharmacists would function as pharmacists should and notify us when patients pick up medicine or if they don't," said Hawaii delegate Randall Suzuka, M.D., of Mililani. "But they don't do that."

Adding insult to injury, Suzuka noted that the state legislature in Hawaii recently provided funding support for pharmacists to help address a job shortage in the field but declined to provide a smaller amount of financial support for medical training.

"People are using the shortage of primary care physicians to justify the independent practice of others," he said.

Given the complexity of the issues involved, delegates ultimately voted to refer the resolution to the Board of Directors.

Electronic Prescription of Controlled Substances

Seeking to make it easier for physicians to write electronic prescriptions for controlled substances that can be sent to pharmacies securely, delegates considered and adopted a resolution that calls for the AAFP to work with the DEA to change current restrictions on this practice.

Virginia alternate delegate Jesus Lizarzaburu, M.D., testifies during the advocacy reference committee hearing that states would benefit from model legislation crafted by the AAFP to guide their advocacy efforts.

Some who testified in support of the measure said electronic prescriptions would reduce the likelihood of any kind of diversion.

Noting that patients being prescribed specific controlled drugs patients need to visit their physician's office every 30 days to refill their prescription, Delaware delegate Hugh Bonner, M.D., of Wilmington, said the process of writing all those prescriptions by hand consumes considerable staff time.

Model State Legislation for Advocacy

With several states expressing an interest in having the AAFP promulgate model state legislation that could be used in their advocacy efforts, delegates considered a resolution that calls on the AAFP to collect information and develop such legislation for distribution to state chapters.

Supporters of the measure said they need more direct assistance in their advocacy efforts, especially given all the other demands on their time and talents.

"We are asking our members to take a leap of faith on patient-centered medical homes and (electronic health records)," said Virginia alternate delegate Jesus Lizarzaburu, M.D., of Yorktown. "This is what our members are asking us for."

Some who opposed the resolution, however, said there may be existing resources that could be used to accomplish this goal without asking the Academy to devote its resources to doing so.

"Before we ask the Academy to reinvent the wheel, let's see what's out there," said Oregon alternate delegate Elizabeth Steiner-Hayward, M.D., of Portland.

Other opponents argued that individual state needs are too specific to create such a resource for nationwide use.

"How do you know whether what's important in one state is important nationally?" asked Ohio alternate delegate Brian Bachelder, M.D., of Akron. "Are we going to ask AAFP to develop a policy for one state?"

Participation in Single-payer Discussions

A resolution specifically asking the AAFP to support a single-payer health care system generated considerable debate. Although the delegates agreed with the reference committee in voting to not adopt this particular measure, the Congress did reaffirm as current policy a second resolution that called on the AAFP to engage in national deliberations on single-payer financing systems.

"This resolution is about being at the table," California alternate delegate Jay Lee, M.D., of Long Beach, said of the second measure. "It's not for or against single payer.

"I think it's critical that we take part in these discussions."

Other Issues

After often spirited debate, delegates adopted a number of other resolutions on various clinical and public health issues, including

a substitute resolution that asks the Academy to support women's rights to reproductive health services and oppose nonevidence-based restrictions on medical care,

a measure that calls for the AAFP to advocate for safe firearm storage regulations and laws that prevent children from accessing firearms,

a resolution that directs the Academy to petition the FDA to require that emergency contraceptives such as levonorgestrel and ulipristal acetate be labeled as being less effective when used in women who are obese, and

a resolution that calls for the AAFP to advocate that the same puchasing age restrictions and labeling requirements currently in place for combustible cigarettes be extended to also include electronic cigarettes.